Textile-based prothesis for laparoscopic surgery

ABSTRACT

The invention relates to a prosthesis ( 1 ) comprising a textile ( 2 ) of elongate shape defining a longitudinal axis A, and a reinforcing element comprising at least one semi-rigid elongate structure ( 8 ) connected to said textile, said structure being substantially parallel to said longitudinal axis A and having a distal end provided with at least one fastening element ( 4 ) distinct from said textile and capable of cooperating with a part of a tool ( 10 ) that is able to pass through said trocar, in order to temporarily couple said prosthesis to said tool.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a Divisional of U.S. patent application Ser. No.16/244,144 filed Jan. 10, 2019, which is a Continuation of U.S. patentapplication Ser. No. 14/784,073 filed Oct. 13, 2015, which is a NationalStage Application of PCT/EP14/061655 under 35 USC § 371 (a), whichclaims priority of French Patent Application Serial No. 13/55261 filedJun. 7, 2013, the disclosures of each of the above-identifiedapplications are hereby incorporated by reference in their entirety.

TECHNICAL FIELD

The present invention relates to a prosthesis based on a biocompatibletextile and more particularly intended to be implanted by laparoscopy,such as, for example, the wall reinforcement prostheses for repair ofhernias.

BACKGROUND

Wall reinforcement prostheses, for example for the abdominal wall, arewidely used in surgery. These prostheses are intended to treat herniasby temporarily or permanently filling a tissue defect. These prosthesesare generally made from a biocompatible prosthetic textile and can havea number of shapes, for example rectangular, circular or oval, dependingon the anatomical structure to which they are to adapt. Some of theseprostheses are made from entirely bioresorbable filaments and areintended to disappear after they have performed their reinforcingfunction during the period of cellular colonization and tissuerehabilitation. Others comprise non-bioresorbable filaments and areintended to remain permanently in the body of the patient.

Moreover, in order to minimize the trauma subsequent to any surgicalintervention, patients are increasingly operated on by laparoscopy whenthe type of intervention performed allows this. Laparoscopy requiresonly very small incisions through which a trocar is passed, with theprosthesis being conveyed inside the trocar to the implantation site.Open surgery is thus avoided, and the patient can soon leave hospital.Laparoscopy is particularly popular in surgical interventions performedin the abdomen, for example the treatment of hernias.

However, the trocars used in laparoscopic surgery generally have arelatively small calibrated diameter, which may vary, for example, from5 to 15 mm, in order to reduce as much as possible the size of theincision that is made. The prosthesis therefore has to be conveyedwithin a conduit of small diameter and must then be deployed at theimplantation site.

To carry out this step, the prosthesis is generally rolled up on itselfin order to make it slide in the conduit of the trocar or is introduceddirectly by force, if appropriate with the aid of laparoscopy forceps.However, the small diameter of the trocar used makes this stepparticularly difficult to carry out. If the rolling-up of the prosthesisis not correctly guided and effected, the textile may form a plug in thetrocar. The prosthesis no longer slides inside the trocar, and it isvery complicated to remove it from the latter. Moreover, even when theprosthesis has been correctly rolled up, the emergence of the prosthesisfrom the trocar and the deployment of the prosthesis at the implantationsite are complex steps. Indeed, the surgeon initially has to pull on theprosthesis in order to free it from the trocar, but without damaging it.He then has to deploy the prosthesis and spread the latter outperfectly. If the prosthesis does not spread out perfectly against theabdominal wall for example, there may be a risk of a soft organ beinginserted between the prosthesis and said wall, which can lead to risksof adherence, pain and intestinal occlusion and can increase thepossibility of recurrence. It is therefore essential for the surgeon toensure that no part of the prosthesis is folded and that no viscera orpart of the intestine is caught between the prosthesis and the abdominalwall. However, on account of the limited space at the implantation site,it may prove complicated to deploy the prosthesis and then to orient itsuitably with respect to the surrounding anatomical structures.

There is therefore still the need for a prosthesis that is based on abiocompatible textile, that can be used for the repair of hernias, thatcan be easily introduced into a conduit such as that of a trocar ofsmall diameter, without damaging said textile, and that is able to bedeployed completely, and preferably easily, once the implantation sitein the body of the patient has been reached.

The present invention aims to meet such a need.

SUMMARY

A first aspect of the invention concerns a prosthesis comprising:

-   -   at least one flexible biocompatible textile having a shape        defining a longitudinal axis A, and    -   at least one reinforcing element for said textile,    -   characterized in that said reinforcing element comprises at        least one semi-rigid elongate structure connected to said        textile, said structure being substantially parallel to said        longitudinal axis A and having a distal end provided with at        least one fastening element distinct from said textile and        capable of cooperating with a part of a tool that is able to        pass through said trocar, in order to temporarily couple said        prosthesis to said tool.

In the present application, the longitudinal axis of a shape isunderstood as the axis aligned on the greatest dimension of said shape.In the case where said shape is a disc and does not have a greatestdimension, the longitudinal axis is a diameter of this disc.

In this application, the distal end of a device means the end farthestfrom the hand of the user, and the proximal end means the end nearest tothe hand of the user. Likewise in this application, the term “distaldirection” means the direction of introduction of the prosthesis intothe body of the patient, and the term “proximal direction” means thedirection opposite to this direction of introduction.

According to the present application, “textile” is understood as anyarrangement or assembly of biocompatible yarns, fibres, filaments and/ormultifilaments, for example obtained by knitting, weaving, braiding, ornon-woven.

In the present application, “biocompatible” is understood as meaningthat the materials having this property can be implanted in the human oranimal body.

Within the meaning of the present application, a “flexible textile” isunderstood as a textile that can be folded up but that does not have aninherent elasticity allowing it to spontaneously recover a spread-outconfiguration once it has been folded up.

Within the meaning of the present application, a “semi-rigid structure”is understood as a structure having a rigidity that allows it to keep atextile spread out in the absence of any stress and to be gripped byinstruments conventionally used in laparoscopic surgery, such asforceps, so as to be able to manipulate the textile, for example.

The prosthesis according to the invention is able to be easily grippedby a part of a tool conventionally used in laparoscopic surgery, forexample by at least one of the jaws of a pair of forceps, and to be thenintroduced into a trocar by a simple distal movement towards theproximal entrance of the trocar, without first having to fold theprosthesis. The nature and the arrangement of the reinforcing element,provided with a fastening element at the distal end thereof, causeautomatic folding along one or more longitudinal folds when, forexample, a jaw of the forceps is engaged in the fastening element andthe prosthesis is then transported towards the trocar. The forceps arethen introduced into the proximal entrance of the trocar and pushedtowards the distal end of the trocar. During this movement, theprosthesis is forced automatically to fold up along one or morelongitudinal folds and, coupled to the forceps, it enters the trocarwithout difficulty. The prosthesis according to the invention could alsobe pushed into the trocar directly by hand by the surgeon, then bylaparoscopy forceps in order to complete the introduction of theprosthesis into the abdomen of the patient, for example.

Thus, the prosthesis is able to adopt an elongate configuration,substantially aligned on its longitudinal axis A and very compact in theradial direction, allowing it to pass through a trocar withoutdifficulty. The prosthesis can thus be folded in order to enter a trocarof small diameter, for example a diameter of 5 to 15 mm.

When the prosthesis emerges from the trocar, the surgeon can make use ofthe reinforcing element to deploy the prosthesis and return the latterto its initial spread-out configuration. The prosthesis is capable ofconforming to the anatomical structures and of remaining in place onceit has emerged from the trocar.

The textile of the prosthesis according to the invention can have anyshape. The textile can have the shape of a disc, in which case one ofits diameters defines the longitudinal axis A of the textile. In oneembodiment, the textile has a generally elongate shape, for example arectangular, oval or elliptic shape, defining a longitudinal axis A. Thetextile can have another initial shape and can then be cut to such anelongate shape, in particular to a shape adapted to the defect, forexample the hernia defect, that is to be treated.

In one embodiment, said generally elongate shape is a rectangle. Inanother embodiment, said generally elongate shape is an ellipse. Suchshapes are particularly advantageous, since they are similar to theanatomical shape of the defect that is to be filled. Moreover, suchprostheses can adopt a compact shape that is substantially aligned ontheir longitudinal axis, permitting easy introduction into a trocar,even one of small diameter.

In one embodiment, the textile is a mesh.

Within the meaning of the present application, a “mesh” is understood asa textile, as defined above, which is openworked, that is to sayprovided with pores that favour recolonization of tissue. Such a meshcan be bioresorbable, permanent or partially bioresorbable. It issufficiently flexible to be folded up at the time of introduction of theprosthesis into the trocar. Such meshes are well known to a personskilled in the art.

In one embodiment of the invention, the mesh is a knit. By virtue of themeshwork of the knit, it is possible to obtain openworked faces thatpromote cell recolonization after implantation. The knit can betwo-dimensional or three-dimensional.

Within the meaning of the present application, a two-dimensional knit isunderstood as a knit having two opposite faces linked to each other bymeshes but devoid of a spacer giving it a certain thickness: such a knitcan be obtained, for example, by knitting yarns on a warp knittingmachine or raschel knitting machine using two guide bars. Examples ofknitting two-dimensional knits suitable for the present invention aregiven in the document WO2009/071998.

According to the present application, a three-dimensional knit isunderstood as a knit having two opposite faces linked to each other by aspacer that gives the knit a significant thickness, said spacer itselfbeing formed from additional linking yarns in addition to the yarnsforming the two faces of the knit. Such a knit can be obtained, forexample, on a double-bed warp knitting or raschel knitting machine usingseveral guide bars. Examples of knitting three-dimensional knitssuitable for the present invention are given in the documentsWO99/05990, WO2009/031035 and WO2009/071998.

The reinforcing element comprises at least one semi-rigid elongatestructure connected to the textile, said structure being substantiallyparallel to said longitudinal axis A.

The materials that may be suitable for producing the reinforcingelement, in particular said structure, of the prosthesis according tothe invention may be chosen from any biocompatible material having acertain rigidity in order to meet the requirements described above.

In one embodiment, said reinforcing element is made of bioresorbablematerial. In the present application, “bioresorbable” or “biodegradable”is understood to mean that the materials having this property areabsorbed and/or degraded by the tissues or washed from the implantationsite and disappear in vivo after a certain time, which may vary, forexample, from a few hours to a few months, depending on the chemicalnature of the materials.

Thus, the reinforcing element acts as a guide for the prosthesis forintroducing the latter into a trocar, then acts as a means of stiffeningthe prosthesis during the positioning and implanting of the prosthesis,after which it gradually degrades, for example when the prosthesis hasbeen fixed or when the textile has been recolonized by the surroundingcells.

For example, the bioresorbable material can be chosen from amongpolylactic acid (PLA), polycaprolactones (PCL), polydioxanones (PDO),trimethylene carbonates (TMC), polyvinyl alcohol (PVA),polyhydroxyalkanoates (PHA), oxidized cellulose, polyglycolic acid(PGA), copolymers of these materials and mixtures thereof. For example,the bioresorbable material can be a copolymer of polylactic acid and ofpolyglycolic acid.

Alternatively, the reinforcing element of the prosthesis according tothe invention is made of a non-bioresorbable material chosen from amongpolypropylenes, polyesters such as polyethylene terephthalates,polyamides, silicones, polyether ether ketone (PEEK), polyaryletherether ketone (PAEK), polyurethanes and mixtures thereof.

In another embodiment, the reinforcing element is formed by acombination of bioresorbable material and of non-bioresorbable material.

The reinforcing element, in particular said structure, of the prosthesisaccording to the invention is connected to said textile. For example,the reinforcing element can be fixed to the textile by sewing,ultrasonic welding, or else by adhesive bonding or moulding.

In one embodiment, the reinforcing element of the prosthesis accordingto the invention is moulded over the textile. Thus, the reinforcingelement is connected to the textile by injection moulding of one or morethermoplastic or thermosetting biocompatible materials. For example, themould of an injection-moulding machine is equipped with an insert gatein which the textile is held. One or more thermoplastic or thermosettingbiocompatible materials are then heated to their melting point andinjected into the mould, the latter having one or more channels of theshape desired for the reinforcing element. The holding of the textile,the precision of the injection volume and the choice of the injectionparameters make it possible to obtain a reinforcing element withoutmaterial loss, without flash and with good surface evenness. Such amethod allows the reinforcing element to be fixed to the textile in aparticularly effective and lasting way.

In one embodiment, the reinforcing element is obtained by moulding acopolymer of polylactic acid and of polyglycolic acid over the textile.

The semi-rigid elongate structure of the reinforcing element of theprosthesis according to the invention has a distal end provided with atleast one fastening element distinct from said textile.

The fastening element of the prosthesis according to the invention iscapable of cooperating with a part of a tool that is able to passthrough said trocar, in order to temporarily couple said prosthesis tosaid tool. Thus, the fastening element can have any shape suitable forthe engagement of a part of a tool that is able to pass through atrocar. For example, with the tool being intended to carry theprosthesis along with it in the distal direction, the fastening elementcan have any shape allowing an element, for example a projectingelement, of the tool to be engaged in the fastening element when thetool is brought towards the fastening element by a distal movement.

The fastening element is preferably dimensioned so as to be able toreceive a projecting element of a laparoscopy tool, for example a jaw ofa pair of forceps, that can pass through a trocar of small diameter, forexample a diameter of 10-15 mm, and also so as to be able itself to passeasily through the trocar when provided with the prosthesis. Thus, forexample, for use of the prosthesis according to the invention with atrocar having an internal diameter of 15 mm, the fastening element hasouter dimensions smaller than a circle with a diameter of 15 mm,preferably smaller than a circle with a diameter of 5 mm.

The present invention thus relates to a prosthesis comprising:

-   -   at least one flexible biocompatible textile having a shape        defining a longitudinal axis A, and    -   at least one reinforcing element for said textile,    -   characterized in that said reinforcing element comprises at        least one semi-rigid elongate structure connected to said        textile, said structure being substantially parallel to said        longitudinal axis A and having a distal end provided with at        least one fastening element distinct from said textile, said        fastening element having outer dimensions smaller than a circle        with a diameter of 15 mm, preferably smaller than a circle with        a diameter of 5 mm.

The fastening element is distinct from the textile. Thus, when the toolis engaged in the fastening element, said tool is not in contact withthe textile, and the risks of the textile being damaged, for example bybeing caught by a projecting part of the tool, are avoided. Therefore,the integrity of the structure of the textile, in particular itsopenworked structure for example, is not affected when the tool iscoupled to the prosthesis.

In one embodiment, the fastening element has the shape of a closed ring.Thus, for example, a jaw of a pair of forceps for a trocar can be easilyengaged in said ring. This engagement makes it possible to couple theprosthesis to the forceps and to introduce the prosthesis into thetrocar at the same time as the forceps, for example once the two jawshave been closed on each other.

In one embodiment, said fastening element has the shape of an open ring,the opening in the ring being situated substantially in the proximalregion of the ring. Thus, when a part of the tool, for example aprojecting element such as the jaw of a pair of forceps, approaches thefastening element via a distal movement with respect to the prosthesis,it can be engaged in the open ring. When the user continues the distalmovement of the tool with respect to the prosthesis, the jaw engaged inthe open ring comes into abutment against the non-open part of the ring,and the prosthesis is thereby coupled to the tool and is carried alongwith the tool in the distal direction.

In one embodiment, said structure comprises at least one rod segmentextending parallel to the longitudinal axis A. Thus, during theintroduction of the prosthesis into the trocar, the rod segment servesas a guide for the natural folding of the textile of the prosthesisalong one or more longitudinal folds parallel to the rod segment.

In one embodiment, the reinforcing element comprises several of saidstructures parallel to one another, each being provided, at the distalend thereof, with a said fastening element. For example, said fasteningelements are aligned along a line transverse to said longitudinal axisA. The surgeon can thus successively engage the different fasteningelements with the same jaw of a pair of forceps, thereby obtaining afirst folding of the textile along one or more longitudinal folds,before introducing the prosthesis into the trocar.

In one embodiment, said structure additionally comprises one or moreoblique rod segments configured to promote the folding of the textilealong one or more longitudinal folds when the textile is subjected to aradial pressure in the direction of its longitudinal axis A. Forexample, the oblique rod segments can be situated generally in aproximal region of the textile and can form an angle of 0 to 50.degree.with the longitudinal axis A, converging towards a rod segment parallelto the longitudinal axis situated in a distal region of the textile.Such an elongate structure allows the prosthesis to be folded upgradually as it enters the trocar, the two oblique rod segments servingas a guide for the textile as it folds up inside the trocar when thetextile is subjected to the radial pressure acting in the direction ofits longitudinal axis A and exerted by the walls of the trocar.

In one embodiment, the prosthesis additionally comprises an indicator ofa defined location of the textile. For example, the prosthesis cancomprise an indicator of the centre of the textile. The centre of thetextile can be the centre of the prosthesis. Such an indicator can helpthe surgeon when placing the prosthesis in the implantation site, thevisibility at such a site generally being reduced and/or obstructed bythe presence of the surrounding organs. Such an indicator can be in theform of a geometric figure. In one embodiment, said indicator forms apart of said elongate structure.

In one embodiment, the prosthesis comprises a means of informationconcerning the orientation of the prosthesis. Thus, at the implantationsite where the visibility is reduced, the surgeon can have informationconcerning the longitudinal or transverse direction of the prosthesis.In one embodiment, said means of information forms a part of saidelongate structure.

In one embodiment of the invention, one face of the textile is coveredby a non-stick coating.

Such a non-stick coating makes it possible in particular to avoid theformation of undesired and serious post-surgical fibrous adhesions.

Within the meaning of the present application, “non-stick” is understoodas a smooth and non-porous biocompatible material or coating that doesnot offer space for cell recolonization and that preferably promotes thegrowth of new peritoneum.

Another aspect of the present invention is a method by which aprosthesis of the kind described above is conveyed to an implantationsite, said method comprising the following steps:

-   -   a part of a tool that is able to pass through a trocar is        engaged in the one or more fastening elements in order to couple        the prosthesis to said tool,    -   the prosthesis is transported to the proximal entrance of the        trocar by a distal movement of the tool,    -   said tool, coupled to the prosthesis, is introduced into the        proximal orifice of the trocar, and said tool and the prosthesis        inside the trocar are pushed by a distal force directed along        the longitudinal axis of the trocar.

The prosthesis is thus pushed along the longitudinal axis of the trocaruntil its end, along with said tool, emerges from the trocar via thedistal orifice thereof.

The push is continued until the whole prosthesis has emerged completelyfrom the trocar.

By virtue of the structure of the prosthesis according to the invention,the step of introducing the prosthesis into the trocar is greatlyfacilitated. Likewise, with the prosthesis folding up automatically intoa compact configuration as it penetrates into the proximal orifice ofthe trocar, it passes through the trocar easily and without damage.

Finally, the prosthesis is returned to its spread-out configuration atthe implantation site by the surgeon unfolding the prosthesis. To dothis, the surgeon can make use of the reinforcing element, which allowsthe unfolded prosthesis to be maintained in a spread-out state in theabsence of any external stress.

BRIEF DESCRIPTION OF THE DRAWINGS

The advantages of the present invention will become clearer from thefollowing detailed description and from the attached drawings in which:

FIG. 1 shows a plan view of a first embodiment of a prosthesis accordingto the invention,

FIG. 2 shows a view of a step during which a jaw of a pair of forcepsable to pass through a trocar is engaged in the fastening elements ofthe prosthesis of FIG. 1,

FIG. 3 is a view, on an enlarged scale, of a jaw of a pair of forcepsbeing engaged in the fastening elements of the prosthesis of FIG. 1,

FIG. 4 is a view of the forceps of FIG. 2 engaged in the fasteningelements of the prosthesis of FIG. 1 on emergence from the trocar,

FIG. 5 is a plan view of a second embodiment of the prosthesis accordingto the invention,

FIG. 6 is a plan view showing a step during which a jaw of a pair offorceps able to pass through a trocar is engaged in the fasteningelement of the prosthesis of FIG. 5.

DETAILED DESCRIPTION OF EMBODIMENTS

FIG. 1 shows an embodiment of a prosthesis 1 according to the invention.The prosthesis 1 comprises a biocompatible textile 2 and a reinforcingelement in the form of two semi-rigid elongate structures 8. Eachelongate structure 8 comprises a rod segment 3 provided with a fasteningelement, in the form of a closed ring 4, at the distal end 3 a thereof.

As will be seen from FIG. 1, the textile 2 has a generally elongateshape defining a longitudinal axis A. In another embodiment, the textilecould have the shape of a disc, in which case one of the diameters ofthe disc would define the longitudinal axis of the textile.

Referring to FIG. 1, the textile 2 is thus delimited by a peripheralouter edge 2 a forming substantially two opposite long sides 2 b, whichare substantially parallel to the longitudinal axis A, and two oppositeshort sides 2 c, which are substantially perpendicular to thelongitudinal axis A. In the example shown, the textile 2 has the generalshape of a rectangle. Such an embodiment is suitable for the repair of ahernia of the abdominal wall, for example.

In other embodiments, the textile 2 could have an oval shape, or anelliptic shape, or be protean.

The textile 2 is made up of an arrangement of biocompatible filaments,such as a knit, a woven or a nonwoven. Preferably, as is shown in FIG.1, the textile 2 is in the form of a mesh, that is to say it hasopenings for better tissue integration. For example, the textile 2 canbe a two-dimensional or three-dimensional knit. Such textiles in theform of meshes or knits are well known to a person skilled in the artand are not described in any greater detail here.

The textile 2 can be bioresorbable, permanent or partiallybioresorbable. As will become clear from the description below, thetextile 2 is sufficiently flexible to be folded up, in particular at thetime of introduction of the prosthesis into a trocar, along one or morelongitudinal folds. In general, however, the textile 2 does not have aninherent elasticity allowing it to spontaneously recover a spread-outconfiguration once it has been folded up. The textile 2 can be suppliedin the form of a band, which one cuts to the dimensions of the defect tobe treated.

Referring again to FIG. 1, and as will become clear on reading thedescription below, the elongate structures 8 are parallel to each otherand parallel to the longitudinal axis A. The rod segments 3 serve as anelement for reinforcing the textile 2, in order to stiffen the latterand keep it in a substantially spread-out state in the absence of anyexternal stress, as shown in FIG. 1, and also as a tool permitting boththe manipulation of the textile 2 and the guiding of the prosthesis 1upon introduction of the latter into a trocar, and also as a tool forassisting in the deployment of the prosthesis 1 when the latter emergesfrom the trocar at the implantation site. For this purpose, the elongatestructures, in particular the rod segments 3, are connected to thetextile 2 and have a rigidity allowing them to keep the textile 2 in itssubstantially spread-out state in the absence of any external stress,and allowing them to be gripped by a tool conventionally used inlaparoscopic surgery, such as forceps intended to pass through a trocar.

The elongate structures 8, in particular the rod segments 3, areconnected to the textile 2. They can be attached to the textile 2 bymeans of a seam, or else by means of an ultrasonic weld, by adhesivebonding, or by injection moulding.

In one embodiment, the rod segments 3 are joined to the textile by meansof injection moulding. Such an embodiment makes it possible to securethe fixing of the rod segments 3 to the textile 2 in a particularlyeffective manner and to produce the prostheses according to theinvention at an industrial scale.

In the technique of injection moulding, a mould is formed in which, forexample with reference to the example shown in FIG. 1, a cavity isprovided that is formed by two channels corresponding to the two rodsegments 3 that are to be obtained, these two channels being parallel toeach other. The textile is held in an insert gate of the mould, the longsides 2 b of its peripheral outer edge 2 a being parallel to the twochannels. The thermoplastic material used to produce the rod segments,for example a copolymer of polylactic acid and of polyglycolic acid, isheated and injected into these channels using an injection mouldingmachine.

After the injection step, the mould is opened and the prosthesis 1 iswithdrawn from the mould. Such a method allows the textile to be“embedded” in the part moulded over it. Thus, the rod segments 3, whichare the overmoulded parts, are connected to the textile 2, without anyrisk of their coming loose or fragmenting.

On account of the nature and the structure of the rod segments 3, thelatter act as guides for introducing the prosthesis 1 into a smallorifice, such as an admission orifice of a trocar, as will become clearfrom the description below.

Thus, in order to easily introduce the prosthesis 1 of FIG. 1 into atrocar, the user makes use of a tool that is able to pass through atrocar, for example forceps 10 as shown in FIGS. 2 and 3. Referring tothese figures, the forceps 10 are provided, at the distal end 10 athereof, with two jaws 11 that are capable of opening and closing inorder to release or, by contrast, imprison a component. The user holdsthe forceps 10 with the two jaws open and engages one 11 of these twojaws successively into each of the two rings 4 present at the respectivedistal ends 3 a of the rod segments 3 (see FIG. 3). On doing this, asshown in FIG. 2, one or more longitudinal folds 5 are created in thetextile 2. Depending on the number of rod segments 3 present, thetextile 2 can form one or more longitudinal folds 5, like an accordion.

In the example shown, the fastening element is a closed ring 4. It isclear from FIG. 3 that such a closed ring 4 could be replaced by an openring (not shown), of which the opening would be situated in the proximalregion of the ring. Indeed, since the forceps 10 are intended to bemoved in the distal direction once coupled to the prosthesis 1, theabsence of material in the proximal region of the ring does not preventthe effective coupling of the prosthesis to the forceps and thetransport of the prosthesis in the distal direction by the tool, oncethe latter has been coupled to the prosthesis.

The ring 4 is dimensioned so as to be able to receive a jaw of a pair offorceps, that can pass through a trocar of small diameter, for example adiameter of 5-15 mm, and also so as to be able itself to pass easilythrough the trocar. Thus, for example, for using the prosthesisaccording to the invention with a trocar having an internal diameter of5-15 mm, the ring 4 has an external diameter of less than 10 mm, forexample of approximately 5 mm.

The fastening element, i.e. the closed ring 4 in the example shown, isdistinct from the textile 2. The ring 4 is not moulded on the textile 2.This is because the ring 4 has to be able to receive a projectingelement of a tool for laparoscopic surgery, in order to be able tocouple the prosthesis to said tool, but said projecting element must notengage the textile 2 itself. Thus, when the tool is engaged in the ring4, said tool is not in contact with the textile 2, and the risks of thetextile 2 being damaged, for example by being caught by a projectingpart of the tool, are avoided. Therefore, the integrity of the structureof the textile, in particular its openworked structure when the textileis a mesh for example, is not affected when the tool is coupled to theprosthesis.

Referring to FIGS. 2 and 3, it is clear that the jaw 11 engaged in thetwo rings 4 is not in contact with the textile 2 and, therefore, doesnot risk damaging the latter. As is shown in FIG. 3, the forceps 10 canbe arranged in a position in which they are substantially aligned on therod segments 3.

Thus, when a user moves the forceps 10 in the distal directionsymbolized by the arrow F in FIG. 3, the prosthesis 1 is transportedalong with the forceps 10 in this same direction. The user thenintroduces the distal end 10 a of the forceps 10 into the proximalentrance (not shown) of the trocar 12 shown in FIG. 4. As the usergradually pushes the distal end 10 a of the forceps 10 inside the trocar12 in the distal direction, the textile 2 is guided by the rod segments3, which are semi-rigid, and it folds up along one or more longitudinalfolds similar to the longitudinal folds 5 of FIG. 2 and aligned on therod segments 3. Thus, the prosthesis 1 adopts a compact configurationthat allows it to easily pass through the trocar 12. The rod segments 3serve as guide elements for the folding of the prosthesis 1 alonglongitudinal folds.

FIG. 4 shows the distal end 10 a of the forceps 10 after passage throughthe trocar 12, at the moment when the forceps emerge from the trocar 12via the distal end 12 a thereof. The textile 2 is coupled to a jaw 11 ofthe forceps 10 by engagement of the rings 4 in this jaw 11. The usercontinues to push the forceps 10 in the distal direction until the wholeprosthesis 1 has emerged completely from the trocar 12. The user thenuncouples the prosthesis 1 from the jaw 11 of the forceps 10, and he isthen able to deploy the prosthesis 1 with the aid of the rod segments 3in order to keep the textile 2, and therefore the prosthesis 1, in aspread-out state.

The prosthesis 1 is then ready to be positioned opposite a hernia defectthat is to be treated. During the positioning of the prosthesis 1, thelatter can be easily manipulated by means of tools conventionally usedin laparoscopic surgery, these tools being able, among other things, totake hold of all or some of the elongate structures 8.

FIGS. 5 and 6 show another embodiment of the prosthesis 1 according tothe invention, in which the textile 2 has generally the shape of anellipse defining a longitudinal axis A. As in the preceding embodiment,the textile 2 is delimited by a peripheral outer edge 2 a formingsubstantially two opposite long sides 2 b, which are substantiallyparallel to the longitudinal axis A, and two opposite short sides 2 c,which are substantially perpendicular to the longitudinal axis A. Anellipse shape of this kind is suitable for the repair or a hernia of theabdominal wall, for example.

In this embodiment, the reinforcing element comprises a semi-rigidelongate structure 8 comprising a rod segment 3, which is generallyaligned on the longitudinal axis A and which is provided with afastening element in the form of a closed ring 4 at the distal end 3 athereof. The rod segment 3 is situated in the distal region of thetextile 2 and, therefore, of the prosthesis 1. The structure 8additionally comprises two oblique rod segments 6, which each form anangle .alpha. with the longitudinal axis A and are generally situatedproximally with respect to the proximal end of the rod segment 3.Finally, the elongate structure 8 also comprises a triangular frame 7extending in the longitudinal direction and arranged between the rodsegment 3 and the oblique rod segments 6. Such a shape of the structure8 facilitates the automatic folding of the textile 2 along longitudinalfolds at the moment when the textile 2, coupled to trocar forceps, isintroduced into a trocar.

Furthermore, the triangular frame 7 forms an indicator of the centre ofthe textile 2 and also a means of information concerning the orientationof the prosthesis 1. This is because the triangular frame 7 itself is ofelongate shape and indicates to the surgeon the longitudinal directionof the prosthesis 1. Finally, the short side of the triangular frame 7indicates the proximal direction, while the angle opposite this shortside indicates to the surgeon the distal direction. Such an indicator ofa defined location of the textile and a such means of informationconcerning the prosthesis are particularly useful to the surgeon whenthe prosthesis 1 has reached the implantation site, where the field ofview is reduced and/or obstructed by the presence of the surroundingorgans.

FIG. 6 shows the step in which a jaw 11 of a pair of forceps 10 iscoupled to the textile 2, and therefore to the prosthesis 1, with a viewto introducing the prosthesis 1 into a trocar (not shown).

The prosthesis according to the invention can thus be easily introducedinto a trocar, without any risk of forming a plug inside the trocar. Byvirtue of its nature and its structure, the reinforcing element of theprosthesis according to the invention stiffens the prosthesis and servesas an element for guiding and transporting the prosthesis inside atrocar conduit of particularly small diameter, such as a diameter of5-15 mm. The reinforcing element, by stiffening the textile of theprosthesis, also serves to spread the prosthesis out at the moment whenthe latter emerges from the trocar at the implantation site.

1. (canceled)
 2. A method of conveying a prosthesis to an implantationsite comprising: providing a prosthesis including at least one flexiblebiocompatible textile having a first face and second face opposite thefirst face, a shape defining a longitudinal axis, and at least onereinforcing element for said textile, wherein the at least onereinforcing element includes a semi-rigid elongate structure fixed tothe first face of the textile, the semi-rigid elongate structure beingsubstantially parallel to the longitudinal axis and having a distal endprovided with at least one fastening element having a shape of a ringdistinct from the textile, engaging the at least one fastening elementwith a part to a tool configured to pass through a trocar, therebycoupling the prosthesis to the tool via the at least one fasteningelement, introducing the part of the tool coupled to the prosthesis intoa proximal orifice of a trocar causing the prosthesis to automaticallyfold into a compact configuration as the tool and the prosthesis ismoved distally to penetrate into the proximal orifice of the trocar, andpassing the prosthesis through a distal orifice of the trocar to thesite of implantation wherein the prosthesis unfolds from the compactconfiguration to a spread-out configuration.
 3. The method of claim 2,wherein the part of the tool is a jaw member of a laparoscopic surgicaltool.
 4. The method of claim 3, wherein the laparoscopic surgical toolis a surgical forceps.
 5. The method of claim 2, wherein passing theprosthesis through the distal orifice of the trocar is continued untilthe whole prosthesis emerges completely from the trocar.
 6. The methodof claim 2, further comprising uncoupling the prosthesis from the tool.7. The method of claim 2, further comprising positioning the prosthesisopposite a hernia defect at the site of implantation.
 8. The method ofclaim 7, further comprising fixing the prosthesis at the site ofimplantation.
 9. The method of claim 2, wherein the prosthesisautomatically folds along one or more longitudinal folds.
 10. The methodof claim 2, wherein the textile alone does not have an inherentelasticity allowing the prosthesis to spontaneously recover a spread-outconfiguration after folding.
 11. The method of claim 2, wherein the ringis an open ring.
 12. The method of 11, wherein an opening in the openring is situated substantially in a proximal region of the open ring.13. The method of claim 2, wherein the ring is a closed ring.
 14. Themethod of claim 2, wherein the at least one reinforcing element islocated on a central longitudinal axis of the first face of the textiledistal a semi-rigid frame located on a center of the first face of thetextile.
 15. The method of claim 2, wherein the at least one reinforcingelement includes a first reinforcing element separate from a secondreinforcing element, the first reinforcing element including a firstfastening element having a shape of a first ring on a distal end thereofand the second reinforcing element including a second fastening elementhaving a shape of a second ring on a distal end thereof, wherein thefirst and second reinforcing elements extend parallel to each other andthe longitudinal axis.
 16. The method of claim 15, wherein engaging theat least one fastening element comprises engaging successively the firstand second rings creating two or more longitudinal folds in the textile.17. A method of conveying a prosthesis to an implantation sitecomprising: engaging at least one fastening element having a shape of aring with a part of a tool configured to pass through a trocar, thefastening element located on a distal end of a semi-rigid reinforcingelement secured to a first face of a textile, the semi-rigid reinforcingelement being substantially parallel to a longitudinal axis of thetextile, and the ring being distinct from the textile, introducing thepart of the tool coupled to the prosthesis into a proximal orifice of atrocar causing the prosthesis to automatically fold into a compactconfiguration as the tool and the prosthesis is moved distally topenetrate into the proximal orifice of the trocar, and passing theprosthesis through a distal orifice of the trocar to the site ofimplantation wherein the prosthesis unfolds from the compactconfiguration to a spread-out configuration.